Cutting edge of endoscopic full-thickness resection for gastric tumor

Figure 4 Illustration of the procedure for non-exposed endoscopic wall-inversion surgery. A: circumferential seromuscular incision is performed laparoscopically outside the serosal markings after endoscopic submucosal injection; B: seromuscular layers are linearly sutured with the lesion inverted toward the inside of the stomach. A surgical sponge as a spacer is inserted between the serosal layer of the inverted lesion and the suture layer; C: Circumferential mucosal incision and the remnant submucosal incisions are made using ESD devices and techniques; D: Defect is closed with several metallic clips. ESD: Endoscopic submucosal dissection.